Johnny Horton, of Santee, S.C., works on the AMES device in the Upper Limb Lab at Shepherd Center. Photo by Louie Favorite

Armeo Spring

Using computer simulation, the Armeo®Spring supports motor recovery and specific movements by prompting patients to practice everyday tasks, such as cooking or grocery shopping, through video games and other repetitive exercises. Photo by Louie Favorite

Upper limb rehabilitation has often played second fiddle to efforts aimed at re-establishing and strengthening lower-limb function. It’s seemingly not been as glorified in the field where images of someone’s first steps seem unrivaled.

Yet, as many people living with tetraplegia will attest, regaining use of their hands and arms may offer even greater independence. This is not to say walking again isn’t an important goal. But many patients say doing so will not help them get dressed, use the bathroom or feed themselves – daily activities that leave them completely dependent on someone else.

Shepherd Center has always been dedicated to helping patients regain use of their arms and hands. Now, with the help of Deborah Backus, Ph.D., director of MS research, Shepherd is expanding its efforts and taking an integrative approach to upper limb research and recovery – and, in turn, giving clinicians and patients the tools they need to see improvements sooner.

By marrying its research program and clinical data collection, researchers are able to ask more pointed questions, and clinicians can better tailor treatments to individual patients. Backus and her team are also determining the most important outcome measures and identifying best practices for using various technologies and activity-based interventions.

“We are taking what we learn through research and feeding it directly into the clinic,” Backus explained. “The upper limb lab actually came out of these efforts and is allowing us to deliver a level of care we haven’t been able to provide before.”

It’s become a symbiotic relationship in which research and clinical practice inform each other. The data is also helping researchers understand how the upper limbs recover following spinal cord injury (SCI).

“We are finding that it’s not all about strength, but also spasticity, sensation and dis-coordination,” Backus added. “Patients often have trouble turning their muscles on and off at the right time.”

One promising approach for these patients, in particular, is a device called AMES. It combines sensory input using vibrators during repeated movement to strengthen what normally happens in the muscles. Research using the device, done in collaboration with creator, Paul Cordo, Ph.D., at Oregon Health and Science University, finds some people have less pain and spasticity and improved coordination, which leads to functional improvements in the use of their limbs. In the research setting, people with tetraplegia participated in 12 to 24 sessions with the device, but dramatic changes in function have been reported in as few as four sessions.

“What we found in our research was great, but even better is that we can use it in the clinic in an everyday setting,” said Casey Kandilakis, PT, a Shepherd Center therapist who splits her time between research and working one-on-one with patients.

She explained there have been real advantages to involving and engaging clinicians in the process, too.

“We are helping them integrate the findings from the literature and our own research studies into more effective, individualized treatment sessions, using the ‘cool tools’ we have,” Kandilakis added.

Another critical goal, Backus noted, is to amass enough data to influence health care reimbursement decisions so people with tetraplegia can access this kind of rehabilitation.

“Shepherd has really advanced its upper limb rehabilitation program,” Backus said. “We are fortunate to have a unique combination of clinical and research focus.”

Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 935 inpatients, 541 day program patients and more than 7,300 outpatients each year.